Shifting the paradigm: Why some pressure injuries may be unpreventable for individuals with spinal cord injury
1Bogie K, 2Henzel K, 2Richmond M, 2Alvarado N, 2McDaniel J, 2Graebert J, 2Schwartz K, 2Lemmer D, 2Seton J, 3Li Y, 3Sun J
1Case Western Reserve University/Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; 2Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA; 3Case Western Reserve University, Cleveland, OH, USA
The development of pressure injuries (PrI) has a devastating impact on quality of life for too many individuals with spinal cord injury (SCI). The impact of pressure and time are related to the quality or resilience of the soft tissues. The central hypothesis being studied is that muscle quality is a critical objective indicator of PrI susceptibility. The study objective is to identify correlations between tissue health biomarkers, muscle quality and PrI development. Our overall goal is to develop a user-centered tool that will enable people with SCI to determine their personalized risk for pressure injury development.
A repeated measures study design was employed. Experimental methods included comprehensive tissue health assessment and gluteal CT scanning carried out at baseline and repeated annually. A weekly phone questionnaire on tissue health status is also administered
Tissue resilience/health under regularly applied physiological loads is obtained using our established non-invasive methodology for assessment of tissue health status - THEToolbox (Tissue Health Evaluation Toolbox). This includes assessments of transcutaneous oxygen (TcPO2) and laser Doppler blood flow (LDF) to monitor tissue oxygenation and skin blood flow together with Near Infra-Red Sensing (NIRS) to monitor muscle blood flow. Tissue health is monitored bilaterally over the ischia when unloaded and when sitting.
Supine pelvic CT scans with contrast are obtained and the gluteal muscle region of interest (ROI) is identified. Hounsfield Unit values used to determine tissue type within the ROI. 2D and 3D reconstruction provide maps of tissue composition within the ROI and changes over time with repeated assessment.
38 individuals have enrolled and had at least one CT scan and tissue health evaluation. Gluteal muscle composition varied greatly in the study cohort. Some individuals have is almost no muscle tissue within the ROI. For these individuals, the ROI is predominantly fatty tissue, with only small areas of lean muscle remaining. Individuals with greater than 10% gluteal intramuscular fat (IMAT) were highly significantly more likely to have a history of severe or recurrent PrI (p<0.001). Changes in muscle quality impact tissue resilience: Mean TcPO2 decreased as IMAT increased (p < 0.05,). Muscle composition impacted the skin blood flow metabolic component, with significant correlations with IMAT (p < 0.01) and lean muscle (p < 0.01). Muscle blood flow decreased significantly (p<0.01) after 10 minutes sitting for individuals with higher IMAT.
Detailed analysis of muscle characteristics and tissue resilience can provide personalized indications of risk status. Changes in muscle quality impact tissue health: Persons with a severe or recurrent PrI history have higher IMAT. Muscle quality is a key biomarker and provides clarification on why some people with SCI develop severe and recurrent PrI while others don’t.
Craig H Nielsen Foundation
Department of Defense Spinal Cord Injury Research Program W81XWH-14-1-0618
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